There’s No Choice Without Single Payer

Written by Jack Mumby and Elliot Swain

You can’t be both pro-choice and against single payer healthcare.

This is no contrarian posture — it is plainly, intuitively true. There’s no meaningful “choice” without actual access to an abortion — which our current system of privatized health insurance constantly denies many women and people with uteruses seeking to exercise their right.

Many liberals have recently applied what we think is a necessary purity test to Sen. Bernie Sanders. It is absolutely right to criticize his accommodation of anti-choice Democrats, who deserve no quarter in the modern progressive movement.

But the moral warrant behind this — that abortion is an issue we must not compromise on — should be extended beyond its most narrow applications. After all, the popular understanding of a “pro-choice” posture towards abortion, that government should take a “hands-off” approach and simply not criminalize abortion or interfere with its access, often falls short.

Law is not the only social force which restricts people’s reproductive agency. In fact, it may not even be the most powerful one.

In a nation where millions lack adequate health coverage, a lack of formal restrictions is a far cry from the guaranteed access to abortion that true reproductive autonomy requires. Most pro-choice advocates realize this — and abortion funds have sprung up to help bridge this gap, but a just society shouldn’t require private charity to cover necessary medical expenses.

Anybody who wants an abortion should be able to get one, period. Abridging that right — whether through the legal system or the market — is a fundamental violation of human dignity.

This considerable — and frequent — overlap between the lived experience of oppression and material, economic conditions is all too obvious for people living on the margins. Abortion is, after all, an economic issue as well — mandatory childbirth keeps people out of the workforce while imposing additional expenses, from childcare to housing. But this continues to elude the well-paid wonks, politicos, and operatives that make up the greater Democratic establishment.

In the wake of the Democratic Party’s colossal defeat by a brutish racist with an authoritarian, but undeniably populist message, many liberals and progressives are wary of sidelining social issues in favor of a more general economic message. “Don’t assume the answer to big [Trump] crowds is moving policy to the left,” Clinton communications director Jennifer Palmieri advised. “It’s all about identity on our side now.”

Meanwhile, the unequivocal leader of the class-focused wing of the party (and perhaps the party at large), Bernie Sanders, has stoked controversy by agreeing that Democrats should be “open to candidates that may not be rigidly pro-choice” — not to mention his active support for Omaha mayoral candidate Heath Mello, who sponsored anti-choice state legislation.

Sanders’ critics are, on this measure, correct — the right to reproductive autonomy must be an absolutely non-negotiable component of any progressive agenda. But the opprobrium that has met Sanders’ and others’ accommodation of legal barriers to abortion must also be extended towards Democrats who tolerate economic barriers to it — in other words, anyone who does not unequivocally support and prioritize single-payer, universal healthcare.

For that reason, we contend that the most substantively anti-choice claim of the 2016 Democratic primary was made by Sanders’ opponent, Hillary Clinton. Warning of the dangers of another “terrible, terrible national debate” on healthcare policy that could lead to the Affordable Care Act’s repeal, she described single-payer as an idea that will “never, ever come to pass.”

And even after the collapse of the GOP’s sadistic healthcare proposal created an opening for a progressive alternative, 95 House Democrats have declined to co-sponsor the Medicare For All Act — still a record level of support, but that number should be zero.

Even under the ACA, 27 million people still lack insurance — presumably at least half of them women or people with uteruses. 1 in 3 women will have an abortion in their lifetime, which means millions of people will be forced to assume a massive financial burden, often thousands of dollars, just to exercise their basic right to reproductive autonomy.

Insisting on the inevitability of a system which, by design, prevents some people from getting necessary medical procedures like abortion, is a curiously limited approach to “choice.” After all, what good does the lack of legal limitation on abortion do for someone who, either way, couldn’t get one without breaking the bank?

Ironically, the incomplete liberal pro-choice position (against legal impediments but at peace with economic ones) echoes the rhetoric of another of Bernie Sanders’ interlocutors — but certainly not the one its proponents identify with. During a CNN townhall debate this year, Sen. Ted Cruz proudly crowed that the Republican healthcare plan would guarantee all Americans “access” to healthcare — Sanders later pointed out that access to something is meaningless if one cannot actually afford to purchase it.

In the same way, access to abortion de jure isn’t worth much to the millions for whom that access doesn’t extend beyond the letter of the law. In advocating for abortion’s mere legality, without asserting it as an inalienable right that no limitation — whether legal or economic — should abridge, the liberal position imitates Cruz’s rhetorical sleight-of-hand.

Indeed, the right seems to have already caught onto this distinction with their advocacy for TRAP laws, which, while written with the intent of restricting abortion, rely on mundane economic forces to accomplish their goal by imposing draconian requirements and prohibitive costs to regulate providers out of existence.

The conservative anti-choice crusaders, in their effort to abridge abortion rights as much as possible, exploit both judicial and economic factors with chilling efficacy. Democrats must match their opponents’ commitment to revoking abortion rights with an equally robust commitment to breaking down all of the barriers to their exercise — and refusing to accept anything short of universal, guaranteed access.

It’s unlikely that those who advocate for reproductive rights, yet bristle at single payer, do so as legalistic pedants, find it acceptable when poor people can’t get abortions, or are insincere in their convictions.

But it is precisely due to the moral urgency of that conviction — that anyone who wants an abortion deserves one, regardless of their circumstances — that anything short of unqualified advocacy for universal healthcare is not enough. Abortion — like all healthcare, is an inalienable human right.